Air pollution: A public health approach for Portugal

Mortality burden of cardiovascular disease attributable to ambient PM2.5 exposure in Portugal, 2011 to 2021

BACKGROUND

Exposure to high levels of environmental air pollution causes several health outcomes and has been associated with increased mortality, premature mortality, and morbidity. Ambient exposure to PM2.5 is currently considered the leading environmental risk factor globally. A causal relationship between exposure to PM2.5 and the contribution of this exposure to cardiovascular morbidity and mortality was already demonstrated by the American Heart Association.

METHODS

To estimate the burden of mortality attributable to environmental risk factors, a comparative risk assessment was performed, considering a "top-down" approach. This approach uses an existing estimate of mortality of the disease endpoint by all causes as a starting point. A population attributable fraction was calculated for the exposure to PM2.5the overall burden of IHD and stroke was multiplied by the PAF to determine the burden attributable to this risk factor. The avoidable burden was calculated using the potential impact fraction (PIF) and considering the WHO-AQG 2021 as an alternative scenario.

RESULTS

Between 2011 and 2021, the ambient exposure to PM2.5 resulted in a total of 288,862.7 IHD YLL and a total of 420,432.3 stroke YLL in Portugal. This study found a decreasing trend in the mortality burden attributable to PM2.5 exposure, for both males and females and different age-groups. For different regions of Portugal, the same trend was observed in the last years. The mortality burden attributable to long-term exposure to PM2.5 was mainly concentrated in Lisbon Metropolitan Area, North and Centre. Changes in the exposure limits to the WHO recommended value of exposure (WHO-AQG 2021) have a reduction in the mortality burden due to IHD and stroke attributable to PM2.5 exposure, in Portugal.

CONCLUSION

Between 2011 and 2021, approximately 22% and 23% of IHD and stroke deaths were attributable to PM2.5 exposure. Nevertheless, the mortality burden attributable to cardiovascular diseases has been decreasing in last years in Portugal. Our findings provide evidence of the impact of air pollution on human health, which are crucial for decision-making, at the national and regional level.

Characterization of water-soluble ions in PM10 over an industrial area in northern Colombia: Temporal variations and correlation with satellite data

This study was designed to assess the concentrations of nine water-soluble ions in PM10 mass at two sites of an open-pit coal mine and to analyze the correlation and variation of the spatial distribution of sulfate ions with the PM10 sulfate aerosol optical depth at 550 nm (suaod550) in two (North and South) stations of the study area. The daily average of PM10 concentrations ranged from 20.48 to 53.10 μg/m3 and thus did not exceed the daily average maximum permissible level of PM10 (100 μg/m3) established in the Colombia standard at any station. The concentrations of nine water-soluble ions in PM10 (Cl-, NO3-, PO43-, SO42- Na+, NH4+, K+, Mg2+, and Ca2+) were determined. The ions under analysis, SO42-, Na+, and NH4+ had the highest concentrations. Combined, they accounted for 75% of the mass of water-soluble ions in a total of 210 samples. The SO42- concentrations in PM10 significantly correlated with suaod550 (r ranging from 0.57 to 0.66), emphasizing the strong effect of suaod550 from Venezuela (Lake Maracaibo) on central and northern Colombia. These results demonstrate that the effects of local sulfate emissions near monitoring sites can be predicted and assessed using satellite data.

Pollutant-meteorological factors and cardio-respiratory mortality in Portugal: Seasonal variability and associations

Seasonal variations in cardiorespiratory diseases may be influenced by air pollution and meteorological factors. This work aims to highlight the relevance of a complete seasonal characterization of the pollutant-meteorological factors and cardio-respiratory mortality in Portugal and the relationships between health outcomes and environmental risk factors. To this end, air pollution and meteorological variables along with health outcomes were analyzed at national level and on a monthly basis for the period of 2011-2020. It was found that cardiorespiratory mortality rates during winter were 44% higher than during the summer. Furthermore, particulate matter with aerodynamic diameters of 10 and 2.5 μm (μm) or smaller (PM10 and PM2.5), carbon monoxide (CO) and nitrogen dioxide (NO2) showed a seasonal variability with the highest concentrations during winter while ozone (O3) presented higher concentrations during spring and summer. PM10, PM2.5 and NO2, showed a positive correlation between seasons, indicating similar patterns of behavior. Canonical correlation analysis (CCA) applied to pollutant-meteorological and cardiorespiratory mortality data indicates a strong linear correlation between pollutant-meteorological factors and health outcomes. The first canonical correlation was 0.889, and the second was 0.545, both statistically significant (p-value < 0.001). The CCA results suggest that there is a strong association between near-surface temperature, relative humidity, PM10, PM2.5, CO and NO2 and health outcomes. The results of this study provide important information of the seasonal variability of air pollutants and meteorological factors in Portugal and their associations with cardiorespiratory mortality.

Health risk assessment for particulate matter: application of AirQ+ model in the northern Caribbean region of Colombia

Air pollution is considered the world's most important environmental and public health risk. The annual exposure for particulate matter (PM) in the northern Caribbean region of Colombia between 2011 and 2019 was determined using PM records from 25 monitoring stations located within the area. The impact of exposure to particulate matter was assessed through the updated Global Burden of Disease health risk functions using the AirQ+ model for mortality attributable to acute lower respiratory disease (in children ≤ 4 years); mortality in adults aged > 18 years old attributable to chronic obstructive pulmonary disease, ischaemic heart disease, lung cancer, and stroke; and all-cause post-neonatal infant mortality. The proportions of the prevalence of bronchitis in children and the incidence of chronic bronchitis in adults attributable to PM exposure were also estimated for the population at risk. Weather Research and Forecasting-California PUFF (WRF-CALPUFF) modeling systems were used to estimate the spatiotemporal trends and calculate mortality relative risk due to prolonged PM_2.5 exposure. Proportions of mortality attributable to long-term exposure to PM_2.5 were estimated to be around 11.6% of ALRI deaths in children ≤ 4 years of age, 16.1% for COPD, and 26.6% for IHD in adults. For LC and stroke, annual proportions attributable to PM exposure were estimated to be 9.1% and 18.9%, respectively. An estimated 738 deaths per year are directly attributed to particulate matter pollution. The highest number of deaths per year is recorded in the adult population over 18 years old with a mean of 401 events. The mean risk in terms of the prevalence of bronchitis attributable to air pollution in children was determined to be 109 per 100,000 inhabitants per year. The maximum RR values for mortality (up 1.95%) from long-term PM_2.5 exposure were predicted to correspond to regions downwind to the industrial zone.

Supplementary information

The online version contains supplementary material available at 10.1007/s11869-023-01304-5.

Association and interaction of O3 and NO2 with emergency room visits for respiratory diseases in Beijing, China: a time-series study

BACKGROUND

Ozone (O₃) and nitrogen dioxide (NO₂) are the two main gaseous pollutants in the atmosphere that act as oxidants. Their short-term effects and interaction on emergency room visits (ERVs) for respiratory diseases remain unclear.

METHODS

We conducted a time-series study based on 144,326 ERVs for respiratory diseases of Peking University Third Hospital from 2014 to 2019 in Beijing, China. Generalized additive models with quasi-Poisson regression were performed to analyze the association of O₃, NO₂ and their composite indicators (O_x and O_x^wt) with ERVs for respiratory diseases. An interaction model was further performed to evaluate the interaction between O₃ and NO₂.

RESULTS

Exposure to O₃, NO₂, O_x and O_x^wt was positively associated with ERVs for total respiratory diseases and acute upper respiratory infection (AURI). For instance, a 10 μg/m³ increase in O₃ and NO₂ were associated with 0.93% (95%CI: 0.05%, 1.81%) and 5.87% (95%CI: 3.92%, 7.85%) increase in AURI at lag0-5 days, respectively. Significant linear exposure-response relationships were observed in O_x and O_x^wt over the entire concentration range. In stratification analysis, stronger associations were observed in the group aged < 18 years for both O₃ and NO₂, in the warm season for O₃, but in the cold season for NO₂. In interaction analysis, the effect of O₃ on total respiratory emergency room visits and AURI visits was the strongest at high levels (> 75% quantile) of NO₂ in the < 18 years group.

CONCLUSIONS

Short-term exposure to O₃ and NO₂ was positively associated with ERVs for respiratory diseases, particularly in younger people (< 18 years). This study for the first time demonstrated the synergistic effect of O₃ and NO₂ on respiratory ERVs, and O_x and O_x^wt may be potential proxies.

Health impact assessment of air pollution in Lisbon, Portugal

BACKGROUND

Lisbon has about 500,000 inhabitants and it's the capital and the main economic hub of Portugal. Studies have demonstrated that exposure to Particulate Matter with an aerodynamic diameter<2.5 μm (PM_2.5) have strong association with health effects. Researchers continue to identify new harmful air pollutants effects in our health even in low levels.

OBJECTIVES

This study evaluates air pollution scenarios considering a Health Impact Assessment approach in Lisbon, Portugal.

METHODS

We have studied abatement scenarios of PM_2.5 concentrations and the health effects in the period from 2015 to 2017 using the APHEKOM tool and the associated health costs were assessed by Value of Life Year.

RESULTS

The mean concentration of PM_2.5 in Lisbon was 23 μg/m³ ± 10 μg/m³ (±Standard Deviation). If we consider that World Health Organization (WHO) standards of PM_2.5 (10 μg/m³) were reached, Lisbon would avoid more than 423 premature deaths (equivalent to 9,172 life years' gain) and save more than US$45 million annually. If Lisbon city could even diminish the mean of PM_2.5 by 5 μg/m³, nearly 165 deaths would be avoided, resulting in a gain of US$17 million annually.

CONCLUSION

According to our findings, if considered the worst pollution scenario, levels of PM2.5 could improve the life's quality and save a significant amount of economic resources.Implications: The manuscript addresses the health effects and costs of air pollution and constitutes an important target for improving public policies on air pollutants in Portugal. Although Portugal has low levels of air pollution, there are significant health and economic effects that, for the most part, are underreported. The health impact assessment approach associated with costs had not yet been addressed in Portugal, which makes this study more relevant in the analysis of policies aimed to drive stricter control on pollutants' emissions. Health costs are a fundamental element to support decision-making process and to orientate the trade-offs in investments for improving public policies so that to diminish health effects, which can impact the management of the local health services and the population's quality of life, especially after the pandemic period when resources are scarce.

Issue 1 - "Update on adverse respiratory effects of outdoor air pollution" Part 2): Outdoor air pollution and respiratory diseases: Perspectives from Angola, Brazil, Canada, Iran, Mozambique and Portugal

OBJECTIVE

To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact.

RESULTS

Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution.

CONCLUSIONS

Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).

Atmospheric pollution and mortality in Portugal: Quantitative assessment of the environmental burden of disease using the AirQ+ model

In Portugal, data on mortality rate attributed to household and ambient air pollution are not reported due to shortness and irregularity of the available data series, and therefore, the disclosure of the national progress in reducing the number of deaths and illnesses from air contamination in exposures to multiple pollutants is incomplete. The present work describes the application of the AirQ+ model developed by the WHO to calculate how much of specific health outcomes is attributable to long-term exposure to atmospheric NO₂, PM_2.5, and O₃ in the population of various municipalities in Portugal, from 2010 to 2019. Linear Mixed Models were used for data analysis and have shown that (i) approximately 5000 deaths per year are attributable to exposure to mixtures of NO₂ and PM_2.5; (ii) the spatial distribution of the proportion of deaths attributable to NO₂, PM_2.5 and O₃ shows significant differences between locations, and (iii) that AirQ+ is a useful tool for the purpose of effective Public Health policymaking and reporting on the national progress to implement the 2030 Agenda.

Spatial and dynamic effects of air pollution on under-five children's lower respiratory infections: an evidence from China 2006 to 2017

Air pollution has been a deeply concerned issue posing an immediate and profound threat to human's lower respiratory health in China. The health of children under 5 years old, regarded as a key index of public health progress in a country, is closely related to the long-term human capital development. Hence, it is vital to investigate the potential association between air pollution and children's lower respiratory health outcomes and to explore related policy implications regarding the public health and the pollution regulation. As air pollutants diffuse across adjacent regions rather easily, considering the spatial spillover effect is meaningful in course of acquiring the aforementioned association. Based on the proposed province-level panel dataset of China during 2006-2017, this study constructs a dynamic spatial panel Durbin model to investigate the impact of air pollution on under-five children's lower respiratory infections. As a result, (1) both air pollution and children's respiratory health have obvious spatial spillover effects, and the latter has an outstanding characteristic of path dependence in time. (2) In the short term, air pollution presents significant negative impact on children's respiratory health, while in the long run, the impact decreases dramatically. (3) Regional comparison indicates that children in the western China are the most susceptible to air pollution followed by children in the central and eastern regions. (4) Other control variables have significant and varying impacts both in the short and long term. Particularly, this paper proves the existence of "siphon effect" in children healthcare system in China. From a broader and more comprehensive perspective, this study provides effective and constructive basis for policy making, in favor of improving children's health under air pollution and promoting sustainable development in China.

How Air Quality Affect Health Industry Stock Returns: New Evidence From the Quantile-on-Quantile Regression

This paper discusses the asymmetric effect of air quality (AQ) on stock returns (SR) in China's health industry through the quantile-on-quantile (QQ) regression method. Compared to prior literature, our study provides the following contributions. Government intervention, especially industrial policy, is considered a fresh and essential component of analyzing frameworks in addition to investors' physiology and psychology. Next, because of the heterogeneous responses from different industries to AQ, industrial heterogeneity is thus considered in this paper. In addition, the QQ method examines the effect of specific quantiles between variables and does not consider structural break and temporal lag effects. We obtain the following empirical results. First, the coefficients between AQ and SR in the health service and health technology industries change from positive to negative as AQ deteriorates. Second, AQ always positively influences the health business industry, but the values of the coefficients are larger in good air. In addition, different from other industries, the coefficients in the health equipment industry are negative, but the values of the coefficients change with AQ. The conclusions provide important references for investors and other market participants to avoid biased decisions due to poor AQ and pay attention to government industrial policies.

1-Nitropyrene Induced Reactive Oxygen Species-Mediated Apoptosis in Macrophages through AIF Nuclear Translocation and AMPK/Nrf-2/HO-1 Pathway Activation

1-Nitropyrene (1-NP), one of the most abundant nitropolycyclic aromatic hydrocarbons (nitro-PAHs), is generated from the incomplete combustion of carbonaceous organic compounds. 1-NP is a specific marker of diesel exhaust and is an environmental pollutant and a probable carcinogen. Macrophages participate in immune defense against the invasive pathogens in heart, lung, and kidney infection diseases. However, no evidence has indicated that 1-NP induces apoptosis in macrophages. In the present study, 1-NP was found to induce concentration-dependent changes in various cellular functions of RAW264.7 macrophages including cell viability reduction; apoptosis generation; mitochondrial dysfunction; apoptosis-inducing factor (AIF) nuclear translocation; intracellular ROS generation; activation of the AMPK/Nrf-2/HO-1 pathway; changes in the expression of BCL-2 family proteins; and depletion of antioxidative enzymes (AOE), such as glutathione peroxidase (GPx), catalase (CAT), and superoxide dismutase (SOD) These results indicate that 1-NP induced apoptosis in macrophages through AIF nuclear translocation and ROS generation due to mitochondrial dysfunction and to the depletion of AOE from the activation of the AMPK/Nrf-2/HO-1 pathway.

Simulation of primary and secondary particles in the streets of Paris using MUNICH

High particle concentrations are observed in the streets. Regional-scale chemistry-transport models are not able to reproduce these high concentrations, because their spatial resolution is not fine enough. Local-scale models are usually employed to simulate the high concentrations in street networks, but they often adopt substantial simplifications to determine background concentrations and use simplified chemistry. This study presents the new version of the local-scale Model of Urban Network of Intersecting Canyons and Highways (MUNICH) that integrates background concentrations simulated by the regional-scale chemistry-transport model Polair3D, and uses the same complex chemistry module as Polair3D, SSH-aerosol, to represent secondary aerosol formation. Gas and aerosol concentrations in Paris streets are simulated with MUNICH, considering a street-network with more than 3800 street segments, between 3 May and 30 June. Comparisons with PM₁₀ and PM_2.5 measurements at several locations of Paris show that the high PM₁₀ and PM_2.5 concentrations are well represented. Furthermore, the simulated chemical composition of fine particles corresponds well to a yearly measured composition. To understand the influence of the secondary pollutant formation, several sensitivity simulations are conducted. Simulations with and without gas-phase chemistry show that the influence of gas-phase chemistry on the formation of NO₂ is large (37% on average over May and across all modelled streets), but the influence on condensables is lower (less than 2% to 3% on average at noon for inorganics and organics), but may reach more than 20% depending on the street. The assumption used to compute gas/particle mass transfer by condensation/evaporation is important for inorganic and organic compounds of particles, as using the thermodynamic equilibrium assumption leads to an overestimation of the organic concentrations by 4.7% on average (up to 31% at noon depending on the streets). Ammonia emissions from traffic lead to an increase in inorganic concentrations by 3% on average, reaching 26% depending on the street segments. Not taking into account gas-phase chemistry and aerosol dynamics in the modelling leads to an underestimation of organic concentrations by about 11% on average over the streets and time, but this underestimation may reach 51% depending on the streets and the time of the day.

PM2.5-bound trace elements in a critically polluted industrial coal belt of India: seasonal patterns, source identification, and human health risk assessment

The concentration of trace elements like Fe, Mn, Cu, Zn, Ni, Pb, Cd, Cr, Co, and As in atmospheric particulate matter (PM2.5) was estimated to investigate their seasonal variation, potential sources, and health risk at Jharia coalfield, India, during May 2018 to April 2019. Measured PM2.5 (170 ± 45 μg/m3) exceeded the National Ambient Air Quality Standards (2009) by a factor of 4.25, the Clean Air Act, National Ambient Air Quality Standards (40 CFR part 50) by a factor of 11, and Air Quality Guidelines of World Health Organization (2005) by a factor of 16. Mean concentration of the trace elements were observed in the order of Fe > Mn > Cu > Zn > Cr > Pb > Co > Ni > Cd > As, highest being perceived at the monitoring sites affected by coal mine fire. The significantly higher HQ values posed by PM2.5-bound Cd, Cr, Cu, Pb, and As and higher HI values (multi-elemental exposure) indicated potential non-carcinogenic risk to the residents of Dhanbad. Higher ECR values in the coal mining areas of JCF indicated higher carcinogenic risk to the population (adults > children) of Dhanbad due to inhalation of PM2.5-bound Cr. Spontaneous combustion of coal in the mines, active mine fire, associated mining activities, heavy vehicular emission, and re-suspended road dust were recognized as the potential sources of the trace elements from the results of PCA and Pearson correlation analysis.

Quantitative analysis of air pollution and mortality in Portugal: Current trends and links following proposed biological pathways

A wealth of studies focusing on the relationships between negative health outcomes and short-term and long-term exposures to environmental risk factors have produced estimates of the burden of disease attributable to air pollution, which have led to the implementation of air pollution control strategies. However, the call to expand those studies, in terms of geographical units of analysis to produce more accurate estimates of the burden of disease in the different countries has been made. Studies of the specific environment-health relationship concerning air pollution in Portugal are scarce and rather descriptive. Therefore, this work assesses the trends both in atmospheric levels of pollutants including particulate matter (PM₁₀), ozone (O₃), nitrogen dioxide (NO₂) and sulphur dioxide (SO₂), and in mortality rates for diabetes, malignant neoplasms and diseases of the respiratory, digestive and circulatory systems, and explores the links between exposure to air pollutants and mortality, following proposed biological pathways and using inferential statistics methods, for the period 2010 to 2017 in Portugal. The following major conclusions were drawn: (i) despite a somewhat initial downward trend in PM₁₀ and a peak in O₃ levels, fairly constant air pollution levels were mostly observed; (ii) concomitantly, increases in age-adjusted mortality rates were significant for all diseases except diabetes; (iii) lower atmospheric levels of pollutants were observed in rural areas, when compared to urban areas, except for ozone; (iv) age-adjusted mortality rates were higher in rural regions, for diabetes, and in urban regions, for malignant neoplasms; (v) for a 10 μg/m³ increase in atmospheric levels of PM₁₀, regression analysis estimated an increase of 0.30% in the mortality rate for diseases of the respiratory, digestive and circulatory systems, and malignant neoplasms combined.

Short-term effects of ambient air pollution on the incidence of influenza in Wuhan, China: A time-series analysis

BACKGROUND

Evidence suggests that air pollution is associated with many adverse health outcomes such as cardiovascular diseases (CVD), respiratory diseases, cancer, and birth defects. Yet few studies dig into the relationship between air pollution and airborne infectious diseases.

METHODS

Daily data on influenza incidence were obtained from Hubei Provincial Center for Disease Control and Prevention (Hubei CDC). Data on air pollutants including nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ground-level ozone (O₃), particulate matter (PM) with aerodynamic diameter ≤ 2.5 μm (PM_2.5), and PM with aerodynamic diameter ≤ 10 μm (PM₁₀) were retrieved from ten national air sampling stations located at Wuhan. We applied generalized additive model (GAM) to estimate the associations between air pollution and the risk of influenza in Wuhan, China during 2015-2017.

RESULTS

In the single-day lag model, the largest effect estimates were observed at lag 0. An increased relative risk (RR) of influenza was significantly associated with a 10 μg/m³ increase in SO₂ (RR: 1.099; 95% confidence interval [CI]: 1.011-1.195), NO₂ (RR: 1.039; 95% CI: 1.013-1.065), and O₃ (RR: 1.005; 95% CI: 0.994-1.016), respectively. In the multi-day lag model, concentrations of SO₂, NO₂, and O₃ were statistically significantly associated with the risk of influenza at lag 0-1. The seasonal analysis suggests that the influence of air pollution on influenza is greater in the cold season as compared in the warm season in the early lag days. The multi-pollutant model indicates that NO₂ may be a potential confounder for co-pollutants.

CONCLUSIONS

Our study shows that air pollution may be associated with the risk of influenza in a broad sense. Therefore, when formulating policies to deal with influenza outbreaks in the future, factors regarding air pollution should be taken into consideration.

Air Pollution and Emergency Hospital Admissions—Evidences from Lisbon Metropolitan Area, Portugal

The relevance of air pollution in the public health agenda has recently been reinforced—it is known that exposure to it has negative effects in the health of individuals, especially in big cities and metropolitan areas. In this article we observed the evolution of air pollutants (CO, NO, NO2, O3, PM10) emissions and we confront them with health vulnerabilities related to respiratory and circulatory diseases (all circulatory diseases, cardiac diseases, cerebrovascular disease, ischemic heart disease, all respiratory diseases, chronic lower respiratory diseases, acute upper respiratory infections). The study is supported in two databases, one of air pollutants and the other of emergency hospital admissions, in the 2005–2015 period, applied to the Lisbon Metropolitan Area. The analysis was conducted through Ordinary Least Squares (OLS) regression, while also using semi-elasticity to quantify associations. Results showed positive associations between air pollutants and admissions, tendentially higher in respiratory diseases, with CO and O3 having the highest number of associations, and the senior age group being the most impacted. We concluded that O3 is a good predictor for the under-15 age group and PM10 for the over-64 age group; also, there seems to exist a distinction between the urban city core and its suburban areas in air pollution and its relation to emergency hospital admissions.

Dynamic linkages among economic development, environmental pollution and human health in Chinese

Background

Research on the relationships between economic development, energy consumption, environmental pollution, and human health has tended to focus on the relationships between economic growth and air pollution, energy and air pollution, or the impact of air pollution on human health. However, there has been little past research focused on all the above associations.

Methods

The few studies that have examined the interconnections between the economy, energy consumption, environmental pollution and health have tended to employ regression analyses, DEA (Data Envelopment Analysis), or DEA efficiency analyses; however, as these are static analysis tools, the analyses did not fully reveal the sustainable economic, energy, environmental or health developments over time, did not consider the regional differences, and most often ignored community health factors. To go some way to filling this gap, this paper developed a modified two stage Undesirable Meta Dynamic Network model to jointly analyze energy consumption, economic growth, air pollution and health treatment data in 31 Chinese high-income and upper-middle income cities from 2013-2016, for which the overall efficiency, production efficiency, healthcare resource utilization efficiency and technology gap ratio (TGR) for all input and output variables were calculated.

Results

It was found that: (1) the annual average overall efficiency in China's eastern region was the highest; (2) the production stage efficiencies were higher than the healthcare resource utilization stage efficiencies in most cities; (3) the high-income cities had lower TGRs than the upper-middle income cities; (4) the high-income cities had higher average energy consumption efficiencies than the upper-middle income cities; (5) the health expenditure efficiencies were the lowest of all inputs; (6) the high-income cities' respiratory disease and mortality rate efficiencies were higher than in the upper-middle income cities, which had improving mortality rate efficiencies; and (7) there were significant regional differences in the annual average input and output indicator efficiencies.

Conclusions

First, the high-income cities had higher average efficiencies than the upper-middle income cities. Of the ten eastern region high-income cities, Guangzhou and Shanghai had average efficiencies of 1, with the least efficient being Shijiazhuang. In the other regions, the upper-middle income cities required greater technology and health treatment investments. Second, Guangzhou, Lhasa, Nanning, and Shanghai had production efficiencies of 1, and Guangzhou, Lhasa, Nanning, Shanghai and Fuzhou had healthcare resource utilization efficiencies of 1. As the average production stage efficiencies in most cities were higher than the healthcare resource utilization stage efficiencies, greater efforts are needed to improve the healthcare resource utilization. Third, the technology gap ratios (TGRs) in the high-income cities were slightly higher than in the upper-middle income cities. Therefore, the upper-middle income cities need to learn from the high-income cities to improve their general health treatment TGRs. Fourth, while the high-income cities had higher energy consumption efficiencies than the upper-middle income cities, these were decreasing in most cities. There were few respiratory disease efficiency differences between the high-income and upper-middle income cities, the high-income cities had falling mortality rate efficiencies, and the upper-middle income cities had increasing mortality rate efficiencies. Overall, therefore, most cities needed to strengthen their health governance to balance economic growth and urban expansion. Fifth, the average AQI efficiencies in both the high-income and upper-middle income cities were higher than the average CO₂ efficiencies. However, the high-income cities had lower average CO₂ emissions and AQI efficiencies than the upper-middle income cities, with the AQI efficiency differences between the two city groups expanding. As most cities were focusing more on air pollution controls than carbon dioxide emissions, greater efforts were needed in coordinating the air pollution and carbon dioxide emissions treatments. Therefore, the following suggestions are given. (1) The government should reform the hospital and medical systems. (2) Local governments need to strengthen their air pollution and disease education. (3) High-income cities need to improve their healthcare governance to reduce the incidence of respiratory diseases and the associated mortality. (4) Healthcare governance efficiency needs to be prioritized in 17 upper-middle income cities, such as Hangzhou, Changchun, Harbin, Chengdu, Guiyang, Kunming and Xi'an, by establishing sound medical management systems and emergency environmental pollution treatments, and by increasing capital asset medical investments. (5) Upper-middle income cities need to adapt their treatment controls to local conditions and design medium to long-term development strategies. (6) Upper-middle income cities need to actively learn from the technological and governance experiences in the more efficient higher-income cities.

Energy Efficiency and Health Efficiency of Old and New EU Member States

Environmental protection and health issues have always been of great concern. This study employed modified Meta-Frontier Dynamic Network Data Envelopment Analysis to explore the environmental pollution effects from energy consumption on the mortality of children and adults, tuberculosis rate, survival rate, and health expenditure efficiencies in 15 old EU states and 13 new EU states from 2010 to 2014. We calculated the overall efficiency scores and technology gap ratios for each old EU and new EU states as well as the efficiencies of non-renewable energy, renewable energy, PM2.5, CO₂, labor, GDP, tuberculosis, child mortality, adult mortality, health expenditure efficiency, and survival efficiency at the health stage. The average annual overall efficiencies of the old EU states are higher than that of the new EU states. Whether in terms of energy efficiencies or health efficiencies, the inputs and outputs of the old EU states are always higher than that of the new EU states. Overall, developing countries in Eastern Europe are lagging behind in terms of energy and health efficiencies. At the same time, the efficiency of child mortality is lower than that of adult mortality, and the efficiency of PM2.5 is higher than that of CO₂ in both old and new EU states.

Forecasting emergency admissions due to respiratory diseases in high variability scenarios using time series: A case study in Chile

Respiratory diseases are ranked in the top ten group of the most frequent illness in the globe. Emergency admissions are proof of this issue, especially in the winter season. For this study, the city of Santiago de Chile was chosen because of the high variability of the time series for admissions, the quality of data collected in the governmental repository DEIS (selected period: 2014-2018), and the poor ventilation conditions of the city, which in winter contributes to increase the pollution level, and therefore, respiratory emergency admissions. Different forecasting models were reviewed using the Akaike Information Criteria (AIC) with other error estimators, such as the Root Mean Square Error (RMSE), for selecting the best approach. At the end, Seasonal Autoregressive Integrated Moving Average (SARIMA) model, with parameters (p,d,q)(P,D,Q)_s=(2,1,3)(3,0,2)₇, was selected. The Mean Average Percentage Error (MAPE) for this model was 7.81%. After selection, an investigation of its performance was made using a cross-validation through a rolling window analysis, forecasting up to 30 days ahead (testing period of one year). The results showed that error do not exceed a MAPE of 20%. This allows taking better resource managing decisions in real scenarios: reactive staff hiring is avoided given the reduction of uncertainty for the medium term forecast, which translates into lower costs. Finally, a methodology for the selection of forecasting models is proposed, which includes other constraints from resource management, as well as the different impacts for social well-being.

The Energy Efficiency and the Impact of Air Pollution on Health in China

The rapid growth of China's economy in recent years has greatly improved its citizens' living standards, but economic growth consumes many various energy sources as well as produces harmful air pollution. Nitrogen oxides, SO₂ (sulfur dioxide), and other polluting gases are damaging the environment and people's health, with a particular spike in incidences of many air pollution-related diseases in recent years. While there have been many documents discussing China's energy and environmental issues in the past, few of them analyze economic development, air pollution, and residents' health together. Therefore, this study uses the modified undesirable dynamic two-stage DEA (data envelopment analysis) model to explore the economic, environmental, and health efficiencies of 30 provinces in China. The empirical results show the following: (1) Most provinces have lower efficiency values in the health stage than in the production stage. (2) Among the provinces with annual efficiency values below 1, their energy consumption, CO₂ (carbon dioxide), and NOx (nitrogen oxide) efficiency values have mostly declined from 2013 to 2016, while their SO₂ efficiency values have increased (less SO₂ emissions). (3) The growth rate of SO₂ efficiency in 2016 for 10 provinces is much higher than in previous years. (4) The health expenditure efficiencies of most provinces are at a lower level and show room for improvement. (5) In most provinces, the mortality rate is higher, but on a decreasing trend. (6) Finally, as representative for a typical respiratory infection, most provinces have a high level of tuberculosis efficiency, indicating that most areas of China are highly effective at respiratory disease governance.

Reliability Validation of a Low-Cost Particulate Matter IoT Sensor in Indoor and Outdoor Environments Using a Reference Sampler

A suitable and quick determination of air quality allows the population to be alerted with respect to high concentrations of pollutants. Recent advances in computer science have led to the development of a high number of low-cost sensors, improving the spatial and temporal resolution of air quality data while increasing the effectiveness of risk assessment. The main objective of this work is to perform a validation of a particulate matter (PM) sensor (HM-3301) in indoor and outdoor environments to study PM2.5 and PM10 concentrations. To date, this sensor has not been evaluated in real-world situations, and its data quality has not been documented. Here, the HM-3301 sensor is integrated into an Internet of things (IoT) platform to establish a permanent Internet connection. The validation is carried out using a reference sampler (LVS3 of Derenda) according to EN12341:2014. It is focused on statistical insight, and environmental conditions are not considered in this study. The ordinary Linear Model, the Generalized Linear Model, Locally Estimated Scatterplot Smoothing, and the Generalized Additive Model have been proposed to compare and contrast the outcomes. The low-cost sensor is highly correlated with the reference measure ( R 2 greater than 0.70), especially for PM2.5, with a very high accuracy value. In addition, there is a positive relationship between the two measurements, which can be appropriately fitted through the Locally Estimated Scatterplot Smoothing model.

How Energy Consumption and Pollutant Emissions Affect the Disparity of Public Health in Countries with High Fossil Energy Consumption

Public health issues are a global focus, but recent research on the links between fossil energy consumption, pollutant emissions, and public health in different regions have presented inconsistent conclusions. In order to quantify the effect of fossil energy use and pollutant emissions on public health from the global perspective, this paper investigates 33 countries with high GDP and fossil energy consumption from 1995 to 2015 using a fixed effect model. Further, this paper utilizes heterogeneity analysis to characterize the disparity of countries with different features. Empirical results indicate that total fossil energy consumption is beneficial to the life expectancy of the population (LEP), but pollutant emissions (PM10 concentration and greenhouse gas scale) have a negative effect on LEP. Moreover, the heterogeneity test indicates that pollutant emissions lowers LEP in net energy importers more than in net energy exporters, and the effect of such emissions in low- and middle-income countries on public health is more harmful than that in high-income countries. These findings suggest that it is a greater priority for governments to strengthen the control of pollutant emissions through enhancing the efficiency of energy consumption, rather than by reducing its scale of use in low- and middle-income, and net energy importing countries. Additionally, governments also need to focus on the volatility of pollutant emissions in high-income countries with necessary control measures.

Dynamic Linkages among Economic Development, Energy Consumption, Environment and Health Sustainable in EU and Non-EU Countries

There is a close and important relationship between environmental pollution and public health, and environmental pollution has an important impact on the public health. This study employed the two-stage meta-frontier dynamic network data envelopment analysis (TMDN-DEA) model to explore the environment pollution effects from energy consumption on the mortality of children and adult, tuberculosis rate, survival rate and health expenditure efficiencies in 28 EU countries and 53 non-EU countries from 2010 to 2014. We calculated the overall efficiency scores and the technology gap ratios of each EU and non-EU countries and the efficiencies of input and output variables in the production and health stage. The average overall efficiencies each year in EU countries are higher than in the non-EU countries. But EU countries have higher energy efficiency than non-EU countries, and non-EU countries have higher health efficiency than EU countries. The health expenditure efficiencies in the EU countries are obviously lower than those in non-EU countries. The renewable energy efficiencies are obviously higher than the non-renewable energy efficiencies; PM2.5 efficiencies are obviously higher than the CO₂ efficiencies and the children’s mortality rate efficiencies are higher than the adult’s mortality rate efficiencies for EU countries and non-EU countries. The government management in the EU and non-EU countries should be strengthened to reduce the air pollutant and carbon dioxide emissions and raise energy transformation to the clean energy in renewable energy and improve health efficiencies in medical and health care field.

Analysis of the diversity in emissions of selected gaseous and particulate pollutants in the European Union countries

The article presents the analysis results of the grouping of the European Union countries with regard to emission levels of gaseous pollutants (NH3, NMVOCs, SO_x, NO_x) and particulate air pollutants (PM10 and PM2.5) which are one of the most dangerous type of pollution for human health. Their long-lasting effects on the human body may negatively affect health and life expectancy. The analysis was based on the taxonomic method of grouping data using the K-means method which is a non-hierarchical method. The analysis used the data published by Eurostat. Organizing countries into categories of emissions of gaseous and dust pollutants to the atmosphere was conducted for four cases: the total level of emission, the level of emissions related to the GDP, the area, and per capita. The Euclidean distance was a measure of the distance between Member States. The obtained results indicate that, depending on the adopted criterion, there is a significant change in the composition of individual clusters. This confirms the assumptions of the Authors who claimed that in order to develop a more comprehensive analysis and assessment of the state of atmospheric pollution in EU countries it is necessary to include additional criteria, other than only the total emission of a given pollution. The objective of the research was to indicate that the analysis of emissions of selected type of pollution, and at the same time most threatening to human health, does not fully reflect the actual state of the problem when presented only in terms of the emitted amount. It is therefore appropriate for EU institutions to take more account of the differences between the individual countries in terms of the criteria presented in the paper, during the decision-making process concerning the sustainable development policy in the field of environmental protection.

Spatial and Temporal Variations of Six Criteria Air Pollutants in Fujian Province, China

Air pollution has become a critical issue in the urban areas of southeastern China in recent years. A complete understanding of the tempo-spatial characteristics of air pollution can help the public and governmental bodies manage their lives and work better. In this study, data for six criteria air pollutants (including particulate matter (PM_2.5, PM₁₀), carbon monoxide (CO), sulfur dioxide (SO₂), nitrogen dioxide (NO₂) and ozone (O₃)) from 37 sites in nine major cities within Fujian Province, China were collected between January 2015 to December 2016, and analyzed. We analyzed the spatial and temporal variations of these six criteria pollutants, as well as the attainment rates, and identified what were the major pollutants. Our results show that: (1) the two-year mean values of PM_2.5 and PM₁₀ exceeded the Chinese National Ambient Air Quality Standard (CAAQS) standard I levels, whereas other air pollutants were below the CAAQS standard I; (2) the six criteria air pollutants show spatial variations (i.e. most air pollutants were higher in the city center areas, followed by suburban areas and exurban areas, except for O₃; and the concentrations of PM₁₀, PM_2.5, NO₂, O₃ were higher in coastal cities than in inland cities); (3) seasonal variations and the no attainment rates of air pollutants were found to be higher in cold seasons and lower in warm seasons, except for O₃; (4) the most frequently present air pollutant was PM₁₀, with PM_2.5 and O₃ being the second and third most frequent, respectively; (5) all the air pollutants, except O₃, showed positive correlations with each other. These results provide additional information for the effective control of air pollution in the province of Fujian.

Quantifying Bicycle Network Connectivity in Lisbon Using Open Data

Stimulating non-motorized transport has been a key point on sustainable mobility agendas for cities around the world. Lisbon is no exception, as it invests in the implementation of new bike infrastructure. Quantifying the connectivity of such a bicycle network can help evaluate its current state and highlight specific challenges that should be addressed. Therefore, the aim of this study is to develop an exploratory score that allows a quantification of the bicycle network connectivity in Lisbon based on open data. For each part of the city, a score was computed based on how many common destinations (e.g., schools, universities, supermarkets, hospitals) were located within an acceptable biking distance when using only bicycle lanes and roads with low traffic stress for cyclists. Taking a weighted average of these scores resulted in an overall score for the city of Lisbon of only 8.6 out of 100 points. This shows, at a glance, that the city still has a long way to go before achieving their objectives regarding bicycle use in the city.